Some of the preventive services of Medicare Part B covers include a one-time “Welcome to Medicare” preventive visit, hepatitis B shots, flu, cardiovascular screenings, diabetes screenings, cancer screenings, and more. For a full list of preventive services covered under Medicare Part B, refer to the Medicare handbook, “ Medicare and You .” If you do not have this book, you can download at medicare.gov.
If you are in a Medicare Advantage plan, you will get both your Medicare Part A and Part B coverage through a private health insurance carrier contracted with Medicare. By law, Medicare Advantage plans must offer at least the same level of coverage as Original Medicare, and some plans include additional coverage not included in Original Medicare such as dental, vision, and hearing, Most with plans include prescription drug coverage.
Eligibility for Medicare Part B
When you turn 65, and you are receiving Social Security retirement benefits or Railroad Retirement Board (RRB) benefits your enrollment in Medicare Part A will be automatic. Medicare Part A benefits begin the first day of your 65th birthday month. If your birthday is on the first day of the month, your benefits will start the month before you become 65. If you enrolled in Medicare Part B when you applied for retirement, your Part B coverage would start at the same time. Your red, white, and blue Medicare card will arrive about three months before your 65th birthday. IEP begins three months before your 65th birthday month and includes the month you turn 65 and ends three months after your 65th birthday month. The start of your coverage depends on when you enroll during the IEP. Be careful not to wait until the last minute to enroll. If you decide not to enroll during your seven-month IEP, then you will have to wait until the next GEP general enrollment period (January 1 to March 31) to enroll.
If you are disabled, enrollment in Medicare Part A hospital insurance (and Medicare Part B medical insurance) will begin after you have been receiving Social Security disability benefits for 24 months. Your coverage will start in the 25th month. Your Medicare card will arrive about three months before your coverage begins.
If you have ALS (also known as Lou Gehrig’s disease), your Medicare Part A hospital insurance (and Medicare Part B medical insurance) will automatically begin the same month that your Social Security disability benefits begin. Your Medicare card will arrive about one month after you sign up for Social Security disability benefits.
If you have an end-stage renal disease (ESRD) and require dialysis, your Medicare effective date is usually the first day of the fourth month of your dialysis treatments. However, you need to apply for Medicare benefits; you’re not automatically enrolled if you’re younger than 65
When to enroll in Medicare Part B
If you are receiving retirement benefits before age 65 or qualify for Medicare through disability, generally you’re automatically enrolled in Medicare Part A and Part B as soon as you become eligible.
If you do not enroll during your initial enrollment period and do not qualify for a special enrollment period, you can also sign up during the annual General Enrollment Period, which runs from January 1 to March 31, with coverage starting July 1. You may have to pay a late enrollment penalty for not signing up when you were first eligible.
Keep in mind that once you are both 65 years or older and have Medicare Part B, your six-month Medigap Open Enrollment Period begins. The best time to purchase a Medicare Supplement insurance plan is during open enrollment; you have a “guaranteed-issue right” to buy any Medigap plan without medical underwriting or paying a higher premium due to a pre-existing condition*. Once you are enrolled in Medicare Part B, be careful not to miss this one-time initial guaranteed-issue enrollment period for Medigap.
Delaying Medicare Part B enrollment
If you delayed enrolling in Medicare Part A, you may enroll during the next available General Enrollment Period, unless you are eligible for a Special Enrollment period (see below). The General Enrollment Period occurs each year from January 1 to March 31. If you sign up during general enrollment, your coverage will begin July 1 of that year, and your Medicare card will arrive about three months before your coverage begins.
If you are still working, you should check with your health benefits administrator to see how your insurance would work with Medicare. If you delay enrollment in Medicare Part B because you already have current employer health coverage, you can sign up later during a Special Enrollment Period without paying a late penalty. You can enroll in Medicare Part B at any time that you are still covered by a group plan based on current employment. After your employer health coverage ends or your employment ends (whichever comes first), you have an eight-month special enrollment period to sign up for Part B without a late penalty.
Keep in mind that retiree coverage and COBRA are not considered health coverage based on current employment and would not qualify you for a special enrollment period. If you have COBRA after your employer coverage ends, you should not wait until your COBRA coverage ends to sign up for Medicare Part B. Your eight-month Part B special enrollment period begins immediately after your current employment or group plan ends (whichever comes first). This is regardless of whether you get COBRA.
Medicare Part B premiums
Medicare Part B premiums may change from year to year, and the amount can vary depending on your situation. For many people, the premium is automatically deducted from their Social Security benefits.
If you were enrolled in Medicare Part B before 2018 and are receiving Social Security benefits, your monthly premium will typically be lower than the standard premium described below. On average, beneficiaries enrolled before 2018 pay about $130. Your monthly premium is generally $134 in 2018 if any of the following applies to you:
You enrolled in Medicare Part B for the first time in 2018. You get billed for your Part B premium (instead of having it automatically deducted from your Social Security benefits). You don’t receive Social Security benefits. You qualify for both Medicare and Medicaid benefits (you’re dual-eligible). Your income exceeds a certain amount. Your premium could be higher than the amount listed above, as there are different premiums for different income levels. See below for more details about the Medicare Part B premium.
If you are receiving Social Security, Railroad Retirement Board, or federal retirement benefits, your Part B premium will be deducted directly from your monthly benefit. If not, you will be sent a bill every three months.
The chart below shows the Medicare Part B monthly premium amounts, based on income. These amounts may change each year. A late enrollment penalty may be applicable if you did not sign up for Medicare Part B when you were first eligible. Your monthly premium may be 10% higher for each 12-month period that you were eligible, but didn’t enroll in Part B.
Medicare Part B monthly premium in 2018
Source: “Part B Costs,” Medicare.gov
You pay
If your yearly income is
If you filed an individual tax return
If you filed a joint tax return
$134 (amount may be lower if you enrolled in Part B before 2018)
$85,000 or less
$170,000 or less
$187.50
$85,001 – $107,000
$170,001 – $214,000
$267.90
$107,001 – $133,500
$214,001 – $267,000
$348.30
$133,501 – $160,000
$267,001 – $320,000
$428.60
Above $160,000
Above $320,000
You pay
If you are married but you file a separate tax return from your spouse, and your yearly income is
$134 (amount may be lower if you enrolled in Part B before 2018)
$85,000 or less
$428.60
Above $85,000
Medicare Part B deductible and coinsurance amounts
The annual deductible for Medicare Part B is $183 in 2018. You will also be responsible for a 20% coinsurance for many covered services. If your doctor or health care provider accepts assignment for a covered service, you would pay the Part B deductible along with 20% of the Medicare-approved amount for services rendered. Accepting assignment means that your doctor will not charge you more than the Medicare-approved amount for the covered service. You would still be responsible for cost-sharing.
*Pre-existing conditions are generally health conditions that existed before the start of a policy. They may limit coverage, be excluded from coverage, or even prevent you from being approved for a policy; however, the exact definition and relevant limitations or exclusions of coverage will vary with each plan, so check a specific plan’s official plan documents to understand how that plan handles pre-existing conditions.
This information is not a complete description of benefits. Contact the plan for more information.
Limitations, copayments, and restrictions may apply.
Benefits may change on January 1 of each year.
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Read More Medicare Part D prescription drug coverage often referred to as Part D, is provided and coordinated by Medicare-approved private insurance companies. Any beneficiary who is eligible for Original Medicare, Part A and/or Part B, and permanently resides in the service area of a Medicare Prescription Drug Plan, can sign-up for Medicare Part D. Medicare Part D coverage is optional, but if you don’t enroll in Part D as soon as you’re eligible, you might pay a late-enrollment penalty if you enroll later.
You can get Medicare Part D coverage through a stand-alone Medicare Prescription Drug Plan if you’re enrolled in Original Medicare. If you’re enrolled in a Medicare Advantage plan, you can get this coverage through a plan that includes drug benefits, also known as a Medicare Advantage Prescription Drug Plan. Different insurers offer different types of plans, so your monthly plan premium and out-of-pocket expenses for prescription drugs will vary from plan to plan.
Every Medicare Prescription Drug Plan has a formulary — which is, a list of covered drugs
It can be a good idea to review your Medicare Prescription Drug Plan coverage every year, to see if your plan covers the medications you need now and may need in the upcoming year.
Finally, be aware that your plan may change its formulary. You may want to review the Annual Notice of Change that the plan sends you every fall to make sure it will still cover your prescription medications in the coming year. Coverage generally follows this pattern:
1. If the Prescription Drug Plan has an annual deductible, you pay the full amount of your prescription drug purchases until the deductible is met.
2. After you satisfy the annual deductible, you will pay a share of the costs according to the terms and structure of your plan. Your share, which you typically pay to the pharmacy at the time of pickup, could be a flat amount (copayment) or a percentage of the total amount (coinsurance).
3. Once you have paid a certain annual maximum amount out of your pocket for prescription drugs, you automatically get “catastrophic coverage.” This means for the rest of that particular year; you would only pay a small copayment or coinsurance amount for prescription drugs.
Be sure to talk to your doctor to see if you are taking the lowest cost medications available to you. Specific coverage may vary from plan to plan, so read your documentation carefully.
Filling the coverage gap
You may have heard of the Medicare coverage gap (also called the “donut hole”) but aren’t clear on how it works. After your Medicare Part D coverage has paid a certain amount for prescription drugs, you may have to pay all costs yourself, up to a yearly limit. This temporary limit on what your Medicare Prescription Drug Plan will pay for covered drugs is the coverage gap. The coverage gap applies to both stand-alone Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug Plans.
The recent federal health-care reform legislation will reduce the coverage gap over several years to make prescription drugs more affordable. There will be additional savings in the coverage gap each year through 2020 when the coverage gap is closed completely. For more information, call us at Indiana Insurance Alliance 765-462-6002 or Email: kjones@INinsureALL.com
Medicare Part D more information Individuals on Medicare are eligible for prescription drug coverage under a Part D plan if they are signed up for benefits under Medicare Part A and/or Part B. Beneficiaries obtain the Part D drug benefit through two types of plans administered by private insurance companies: the beneficiaries can join a stand-alone Prescription Drug Plan (PDP) for drug coverage only, or they can join a public Part C health plan (Medicare Advantage) that jointly covers all hospital and medical services covered by Medicare Part A and Part B at a minimum, and typically covers additional healthcare costs not covered by Medicare Parts A and B including prescription drugs (MA-PD). (NOTE: Medicare beneficiaries need to be signed up for both Parts A and B to select Part C whereas they need only A or B to select Part D.)
About two-thirds of all Medicare beneficiaries are enrolled directly in Part D or get Part-D-like benefits through a public Part C Medicare Advantage health plan. Another large group of Medicare beneficiaries gets prescription drug coverage under plans offered by former employers or through the Veterans Administration. It is also possible that a former employer or union might sponsor a Part D plan for former employees/members (such plans are called Employer Group Waiver Plans).
Medicare beneficiaries can enroll directly through the plan's administrator, or indirectly via an insurance broker like Indiana Insurance Alliance. Beneficiaries already on a plan can choose a different plan or drop Part C/D during the annual enrollment period or during other times during the year. For some time, the annual enrollment period has lasted from October 15 to December 7 of each year. Low-income seniors on Social Security Extra Help/LIS and many middle-income seniors on state pharmaceutical assistance programs can choose a different plan or drop Part C/D (or join Part C/D plan for that matter) as often as once a month. Other special enrollment circumstances apply. Call an independent broker like Indiana Insurance Alliance for assistance.
Medicare beneficiaries who were eligible for but did not enroll in Part D when they were first eligible and later want to enroll, pay a late-enrollment penalty, basically a premium surtax, if they did not have acceptable coverage through another source such as an employer or the U.S. Veterans Administration
In May 2018, enrollment exceeded 44 million, including both those on standalone Part D and those enrolled in Part C plan (which includes Part-D-like coverage).
As of May 2018, over 700 drug plan contracts have been signed between CMS and administrators, which in turn means multiple thousand plans because administrators can vary plans by county. Individual counties might have as few as three to as many 30 plans from which beneficiaries can choose. This allows participants to select a plan that best meets their individual needs. Although the number of plans available has been trending down since the inception of the program, almost all counties offer many choices.
Plan administrators are required to offer a plan with at least the "standard" minimum benefit or one that is actuarially equivalent to the standard, and they may also offer plans with more generous benefits (e.g., no deductible during the initial spend phase). The terms "standard," "actuarially equivalent," and "more generous" relate to the plan's deductible/co-pay/formulary/"donut-hole" (see Note)/pharmacy-preference aspects and has no direct relevance to the beneficiary other than increasing or decreasing personal choice. The CMS approves each plan before being marketed.
It is often said the donut hole will be eliminated; that is not technically true. The "donut hole" is also called the gap phase of spending; at one time the co-pay in the gap was 100%. As of 2019, the "standard" co-pay in the gap will be 25%, the same as in the initial spend phase. It is also important to note that relatively few people as a percent of the total number of people on Medicare are ever finan
